JOHNSTON MEMORIAL HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
JOHNSTON MEMORIAL HOSPITAL INC (EIN 54-0544705)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-14
IRS object ID
201211359349302296
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-14T11:07:12-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PERSHING YOAKLEY & ASSOCIATES P CBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1ONE CHEROKEE MILLS 2220 SUTHERLANDAddressLine1
CityKNOXVILLECity
StateTNState
ZIP Code379192363ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN540544705EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1JOHNSTON MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlJOHNNameControl
Phone2762581000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line116000 JOHNSTON MEMORIAL DRIVEAddressLine1
CityABINGDONCity
StateVAState
ZIP Code24211ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOHN L JETERName
TitleCFOTitle
Phone2762581000Phone
Date Signed2012-05-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDEBORAH O ERNSBERGERName
Phone8656730844Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeXAddressChange
Name Of Principal Officer PersonJOHN L JETERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line116000 JOHNSTON MEMORIAL DRIVEAddressLine1
CityABINGDONCity
StateVAState
ZIP Code24211ZIPCode
FieldValueIRS element (for citing)
Gross Receipts116176964GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteHTTP://WWW.JMH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1917YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionTO RESPOND TO THE HEALTHCARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers80TotalNbrVolunteers
Total Gross UBI9355TotalGrossUBI
Net Unrelated Business Txbl Income7519NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year85272ContributionsGrantsPriorYear
Contributions Grants Current Year18506ContributionsGrantsCurrentYear
Program Service Revenue Prior Year105584171ProgramServiceRevenuePriorYear
Program Service Revenue CY111418571ProgramServiceRevenueCY
Investment Income Prior Year6294232InvestmentIncomePriorYear
Investment Income Current Year3914394InvestmentIncomeCurrentYear
Other Revenue Prior Year382119OtherRevenuePriorYear
Other Revenue Current Year635944OtherRevenueCurrentYear
Total Revenue Prior Year112345794TotalRevenuePriorYear
Total Revenue Current Year115987415TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year88355GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY90098GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year45020126SalariesEtcPriorYear
Salaries Etc Current Year48436329SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year3393TotalFundrsngExpCurrentYear
Other Expense Prior Year58620461OtherExpensePriorYear
Other Expenses Current Year58964455OtherExpensesCurrentYear
Total Expenses Prior Year103728942TotalExpensesPriorYear
Total Expenses Current Year107490882TotalExpensesCurrentYear
Revenues Less Expenses Prior Year8616852RevenuesLessExpensesPriorYear
Revenues Less Expenses CY8496533RevenuesLessExpensesCY
Total Assets BOY321503562TotalAssetsBOY
Total Assets EOY349751817TotalAssetsEOY
Total Liabilities BOY49582770TotalLiabilitiesBOY
Total Liabilities EOY64585564TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY271920792NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY285166253NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionJOHNSTON MEMORIAL HOSPITAL, INC. IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense74166645Expense
Grants90098Grants
Revenue111418571Revenue
DescriptionJOHNSTON MEMORIAL HOSPITAL ("HOSPITAL") IS A TAX-EXEMPT COMMUNITY-BASED HOSPITAL, WHICH IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTHCARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. TEAM MEMBERS OF JOHNSTON MEMORIAL HOSPITAL RECOGNIZE A CORE SET OF VALUES TO HELP ASSURE OUR PATIENTS RECEIVE HIGH QUALITY AND COMPASSIONATE CARE AT A REASONABLE COST. THESE VALUES ARE:- INTEGRITY - HONESTY IN EVERYTHING WE DO- SERVICE - WITH CARING AND COMPASSION- LEADERSHIP - WITH CREATIVITY AND INNOVATION- EXCELLENCE - ALWAYS PURSUING A HIGHER STANDARDIN FISCAL YEAR 2010, JOHNSTON MEMORIAL HOSPITAL PROVIDED PATIENT CARE TO OVER 5,883 IN-PATIENTS, REPRESENTING 22,427 INPATIENT DAYS AND 1,311 NEWBORN DAYS. WE ALSO PROVIDED OUTPATIENT SERVICES TO OVER 154,021 PATIENTS. CARE GIVEN TO MEDICARE AND MEDICAID PATIENTS MAKE UP APPROXIMATELY 67% OF THE HOSPITAL'S TOTAL PATIENT REVENUE.COMMUNITY HEALTH EDUCATION AND OTHER COMMUNITY SUPPORTRECOGNIZING OUR MISSION TO THE COMMUNITY IN THE AREA OF HEALTHCARE EDUCATION, JOHNSTON MEMORIAL HOSPITAL AND ITS TEAM MEMBERS OFFER MANY FREE PROGRAMS THROUGHOUT THE YEAR AIMED AT IMPROVING COMMUNITY HEALTH. WE OFFERED THE FOLLOWING EDUCATIONAL CLASSES AND PROGRAMS:- ONGOING CANCER EDUCATION CLASSES- ONGOING DIABETES EDUCATION- ADVANCED CARDIAC LIFE SUPPORT CERTIFICATION COURSE- PEDIATRIC ADVANCED LIFE SUPPORT CERTIFICATION COURSE- CARDIO PULMONARY RESUSCITATION CERTIFICATION COURSE- TOTAL JOINT CLASSES- BABY ON THE WAY, BREASTFEEDING, PARENTING COURSES- ANNUAL BABY FAIR- PROSTATE CANCER SCREENING- AED TRAINING AND EDUCATION- DIABETES EDUCATION HEALTH FAIR- HEART SAVER FIRST AID CLASSES FOR DAY CARE, SCHOOLS, CHURCHES, ETC.- MONTHLY LUNCH AND LEARN AT LOCAL RECREATION CENTER- HEALTHY COOKING DEMONSTRATION- ANNUAL SPORTS PHYSICALS FOR LOCAL HIGH SCHOOLSWE SPONSORED OR ASSISTED LOCAL SUPPORT GROUPS IN THE FOLLOWING PROGRAMS:- HEART-TO-HEART EDUCATIONAL SUPPORT GROUP- CANCER EDUCATION SUPPORT GROUP- DIABETES EDUCATION SUPPORT GROUP- RESOLVE THROUGH SHARING SUPPORT GROUP - FOR THOSE GRIEVING THE LOSS OF NEWBORNS- ANNUAL ASTHMA CAMP- LADIES NIGHT OUT (BREAST CANCER AWARENESS EVENT)JOHNSTON MEMORIAL HOSPITAL RECOGNIZES THE IMPORTANCE OF HEALTHCARE EDUCATIONAL PROGRAMS TOWARD PROVIDING QUALITY HEALTHCARE TO OUR COMMUNITIES. IN FISCAL YEAR 2010, WE SUPPORTED A NURSING INSTRUCTOR POSITION AT THE LOCAL COMMUNITY COLLEGE TO ASSIST IN MAINTAINING AND DEVELOPING THE NURSING PROGRAM. IN ADDITION, WE PROVIDED A CLINICAL SETTING FOR MANY STUDENTS TRAINING IN HEALTH RELATED PROGRAMS SUCH AS REGISTERED NURSING, LICENSED PRACTICAL NURSING, RADIOLOGY, LAB, AND RESPIRATORY. JOHNSTON MEMORIAL HOSPITAL ALSO RECOGNIZES THE IMPORTANCE OF SUPPORTING OUR NOT-FOR-PROFIT COMMUNITY BASED ORGANIZATIONS IN FUNDRAISING AND OTHER EVENTS. THE HOSPITAL AND OUR EMPLOYEES CONTRIBUTED OVER $150,000 IN CASH AND IN-KIND CONTRIBUTIONS TO OUR COMMUNITY IN FISCAL YEAR 2009 TO SUCH ORGANIZATIONS AS THE AMERICAN LUNG ASSOCIATION, MARCH OF DIMES, UNITED WAY, RELAY FOR LIFE CANCER FUNDRAISER, AND MANY OTHERS.Description
Total Program Service Expense74166645TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096123NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledVAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JOHN L JETERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2762581000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line116000 JOHNSTON MEMORIAL DRIVEAddressLine1
CityABINGDONCity
StateVAState
ZIP Code24211ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
BARBARA ALLEN
TRUSTEE VICE CHAIR1.00X000
PAUL ARMSTRONG MD
TRUSTEE/PHYSICIAN1.00X030120320826
OTEY DUDLEY
TRUSTEE CHAIR1.00X000
W HOUSTON FERGUSON III
TRUSTEE SECRETARY1.00X000
ANN FLEMING
TRUSTEE/MSHA SVP1.00X044279565589
J THOMAS FOWLKES
TRUSTEE PRESIDENT1.00X000
DON JEANES
TRUSTEE TREASURER1.00X000
BRENDAN MCSHEEHY JR
TRUSTEE1.00X000
EMORY ROBINETTE MD
TRUSTEE/PHYSICIAN1.00X1500000
MARY RUSSELL
TRUSTEE1.00X000
MIKE SPIEGLER
TRUSTEE1.00X000
LARAMIE TRIPLETT MD
TRUSTEE/PHYSICIAN1.00X0724760
CHARLES SYDNOR
TRUSTEE1.00X000
WILLIAM WALKER MD
TRUSTEE/PHYSICIAN1.00X06120041615
CHRIS WALTERS
TRUSTEE1.00X000
SEAN S MCMURRAY
VP & CHIEF EXECUTIVE OFFICER55.00030893747024X
TIMOTHY G EVANS
CHIEF FINANCIAL OFFICER55.00017723221837X
STEPHEN K GIVENS
CHIEF OPERATING OFFICER55.00018543127884X
STEPHEN BLANKENSHIP MD
PHYSICIAN55.00030797531311X
ANN CHANG MD
PHYSICIAN55.00030960424455X
DAVID SIMMONS MD
PHYSICIAN55.00029661424936X
ANDREW HAWKINS MD
PHYSICIAN55.00029685531202X
STEVEN SIKORA MD
PHYSICIAN55.00029349722910X
FieldValueIRS element (for citing)
Total Reportable Comp From Org15000TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3604623TotalReportableCompFrmRltdOrgs
Total Other Compensation319589TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
VIRGINIA HIGHLANDS ANESTHESIA
PO BOX 1476ABINGDONVA24210ANESTHESIA2367380
EARL SWENSSON ASSOCIATES
PO BOX 410628NASHVILLETN37241CONSTRUCTION DESIGN785645
MEDIAS LLC
PO BOX 10452BLACKSBURGVA24062SLEEP STUDY587690
ABINGDON PHYS AMB SURG MGMT GROUP
613 CAMPUS DRIVE STE 300ABINGDONVA24210ASC MANAGEMENT524488
BLUE RIDGE MEDICAL SPECIALISTS PC
271 MEDICAL PARK BLVDBRISTOLTN37620ONCOLOGY439450
FieldValueIRS element (for citing)
Number Of Contractors GT100 K11NumberOfContractorsGT100K
Related Organizations10931RelatedOrganizations
All Other Contributions7575AllOtherContributions
Total Contributions18506TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
NET PATIENT REVENUE6215001111169671111082028765
PARTNERSHIP INCOME561000301604590$301,014
FieldValueIRS element (for citing)
Total Program Service Revenue111418571TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3854655TotalRevenueColumn
Exclusion$3,854,655ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real233707Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real233707Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column233707TotalRevenueColumn
Exclusion$233,707ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities242476Securities
Other6812Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities189549Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities52927Securities
Other6812Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column59739TotalRevenueColumn
Exclusion$59,739ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA722100147589$147,589
MANAGEMENT FEE561000144635$144,635
PURCHASE DISCOUNTS90009949886$49,886

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column60127TotalRevenueColumn
Exclusion$60,127ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue402237TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column115987415TotalRevenueColumn
Related Or Exempt Function Income111108202RelatedOrExemptFunctionIncome
Unrelated Business Revenue9355UnrelatedBusinessRevenue
Exclusion$4,851,352ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total90098Total
Program Services90098ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total774306Total
Program Services16250ProgramServices
Management And General758056ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total40836640Total
Program Services33529849ProgramServices
Management And General7306791ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1444331Total
Program Services1203865ProgramServices
Management And General240466ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3052068Total
Program Services2936609ProgramServices
Management And General115459ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2328984Total
Program Services2199820ProgramServices
Management And General129164ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total53663Total
Management And General53663ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total358857Total
Management And General358857ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total79945Total
Management And General79945ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total160286Total
Management And General160286ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total9924246Total
Program Services6762867ProgramServices
Management And General3157986ManagementAndGeneral
Fundraising3393Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total312964Total
Program Services250649ProgramServices
Management And General62315ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2288935Total
Program Services1831977ProgramServices
Management And General456958ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total918867Total
Program Services908170ProgramServices
Management And General10697ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2277133Total
Program Services2102154ProgramServices
Management And General174979ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total105420Total
Program Services96187ProgramServices
Management And General9233ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total90541Total
Program Services77865ProgramServices
Management And General12676ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2178653Total
Management And General2178653ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total13442260Total
Program Services35468ProgramServices
Management And General13406792ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total-432152Total
Program Services17543ProgramServices
Management And General-449695ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES & DRUG2015142519372188779237
MANAGEMENT FEES36057823605782
REPAIRS & MAINTENANCE2367528235004717481
BAD DEBT585686585686
OTHER491117385039106078

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total3299Total
Management And General3299ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total107490882Total
Program Services74166645ProgramServices
Management And General33320844ManagementAndGeneral
Fundraising3393Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY10247304BOY
EOY2305269EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1545175BOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY18087850BOY
EOY16224301EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY1397394BOY
EOY984575EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3820438BOY
EOY4049872EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1073714BOY
EOY822058EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis226744008LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec46362239LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY107819626BOY
EOY180381769EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY86216282BOY
EOY116676009EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY35200BOY
EOY35200EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY91260579BOY
EOY28272764EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY321503562BOY
EOY349751817EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY16442094BOY
EOY18255842EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY15240000BOY
EOY14115000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY17900676BOY
EOY32214722EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY49582770BOY
EOY64585564EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY271920792BOY
EOY285151875EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
EOY14378EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY271920792BOY
EOY285166253EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY321503562BOY
EOY349751817EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses8496533ReconcilationRevenueExpenses
Reconcilation Other Changes4748928ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis5009848OtherCostOrOtherBasis
Book Value5009848BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1073610OtherCostOrOtherBasis
Depreciation643784Depreciation
Book Value429826BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis935572OtherCostOrOtherBasis
Depreciation299942Depreciation
Book Value635630BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis90339913OtherCostOrOtherBasis
Depreciation45416927Depreciation
Book Value44922986BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis129385065OtherCostOrOtherBasis
Depreciation1586Depreciation
Book Value129383479BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings180381769TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
OTHER ASSETS525623
DUE FROM AFFILIATES17967933
BOND INDENTURE AGREEMENT3340591
MSHA 2009 PROJECT FUND6438617
FieldValueIRS element (for citing)
Total Book Value Other Assets28272764TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
CAPITAL LEASE OBLIGATIONS$31,564,974
MEDICARE AND MEDICAID, NET$649,748
FieldValueIRS element (for citing)
Total Of Amounts32214722TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE HOSPITAL AND APP ARE CLASSIFIED AS ORGANIZATIONS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. AT JUNE 30, 2011, TAX RETURNS FOR FISCAL YEARS 2008 THROUGH 2010 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOSPITAL HAS NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2011 AND 2010. AS SUCH, NO INTEREST OR PENALTIES ARE RECOGNIZED IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS RELATED TO UNCERTAIN TAX POSITIONS.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage380.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1824766TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense1824766NetCommunityBenefitExpense
Percent Of Total Expense0.01710PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense12904685TotalCommunityBenefitExpense
Direct Offsetting Revenue9434767DirectOffsettingRevenue
Net Community Benefit Expense3469918NetCommunityBenefitExpense
Percent Of Total Expense0.03250PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense494781TotalCommunityBenefitExpense
Direct Offsetting Revenue432933DirectOffsettingRevenue
Net Community Benefit Expense61848NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense15224232TotalCommunityBenefitExpense
Direct Offsetting Revenue9867700DirectOffsettingRevenue
Net Community Benefit Expense5356532NetCommunityBenefitExpense
Percent Of Total Expense0.05020PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense105857TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense105857NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense397050TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense397050NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense66430TotalCommunityBenefitExpense
Net Community Benefit Expense66430NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense569337TotalCommunityBenefitExpense
Net Community Benefit Expense569337NetCommunityBenefitExpense
Percent Of Total Expense0.00530PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense15793569TotalCommunityBenefitExpense
Direct Offsetting Revenue9867700DirectOffsettingRevenue
Net Community Benefit Expense5925869NetCommunityBenefitExpense
Percent Of Total Expense0.05550PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Total Community Building Expense23510TotalCommunityBuildingExpense
Net Community Building Expense23510NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense23510TotalCommunityBuildingExpense
Net Community Building Expense23510NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,688,088BadDebtExpenseAmount
Amount Attributable To1612853AmountAttributableTo
Amount Reimbursed By Medicare35058170AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare42755290CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-7697120MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1JOHNSTON MEMORIAL HOSTPITAL INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1351 COURT STREET NEAddressLine1
CityABINGDONCity
StateVAState
ZIP Code24210ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1JOHNSTON MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 6A: MOUNTAIN STATES HEALTH ALLIANCE (MSHA) PREPARED AN ANNUAL WRITTEN REPORT THAT DESCRIBES THE ORGANIZATION'S PROGRAMS AND SERVICES THAT PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. JMH, AS A MEMBER OF MSHA, IS INCLUDED IN MSHA'S REPORT.
PART I, LINE 7: A COST TO CHARGE RATIO WAS DERIVED FROM THE SCHEDULE H APPLICABLE WORKSHEETS, INCLUDING WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES.
PART I, L7 COL(F): BAD DEBT EXPENSE OF $585,686 IS INCLUDED IN THE STATEMENT OF FUNCTIONAL EXPENSES ON FORM 990, PART IX, LINE 25, BUT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING PERCENTAGES ON PART 1, LINE 7, COLUMN F.
PART II: THE ACTIVITIES REPORTED IN PART II SEEK TO ACHIEVE SPECIFIED OBJECTIVES, INCLUDING: IMPROVING ACCESS TO HEALTH SERVICES, ENHANCING PUBLIC HEALTH, AND RELIEF OF GOVERNMENT BURDEN. THE ACTIVITIES ARE AVAILABLE TO THE GENERAL PUBLIC, FOCUSING ON LOW-INCOME CONSUMERS.
PART III, LINE 4: WORKSHEET A WAS USED FOR PART III, LINES 2 AND 3 IN DETERMINING BAD DEBT AT COST. JMH FOLLOWS THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION'S PRINCIPLES AND PRACTICES BOARD ISSUED STATEMENT 15: VALUATION AND FINANCIAL STATEMENT PRESENTATION OF CHARITY CARE AND BAD DEBTS BY INSTITUTIONAL HEALTHCARE PROVIDERS ("THE STATEMENT"). THE STATEMENT PROVIDES GUIDANCE ON COLLECTABILITY CRITERIA AND EMPHASIZES REVENUE RECOGNITION ONLY WHEN COLLECTIONS ARE REASONABLY ASSURED. FOOTNOTE DISCLOSURE FROM JMH'S FISCAL YEAR 2011 AUDITED FINANCIAL STATEMENT READS "IN NOVEMEBER 2006, THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION'S (HFMA) PRINCIPLES AND PRACTICES BOARD ISSUED STATEMENT 15: VALUATION AND FINANCIAL STATEMENT PRESENTATION OF CHARITY CARE AND BAD DEBTS BY INSTITUTIONAL HEALTHCARE PROVIDERS (THE "STATEMENT"). THE STATEMENT PROVIDES GUIDANCE ON COLLECTABILITY CRITERIA AND EMPHASIZES REVENUE RECOGNITION ONLY WHEN COLLECTIONS ARE REASONABLY ASSURED. THE HOSPITAL ADOPTED THE STATEMENT AND EVALUATED ITS REVENUE RECOGNITION POLICIES RELATED TO CERTAIN TYPES OF PATIENT REVENUE (PRIMARILY SELF-PAY). AS A RESULT, AMOUNTS PREVIOUSLY RECOGNIZED AS NET PATIENT SERVICE REVENUE AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS ARE NO LONGER RECOGNIZED AS NET PATIENT REVENUE AND ESTIMATED PROVISION FOR BAD DEBT IN THE ACCOMPANYING FINANCIAL STATEMENTS."TO FURTHER EXPLAIN JMH'S REPORTING OF BAD DEBT EXPENSE, JMH'S FINANCIAL STATEMENT ACCOUNTS FOR BAD DEBT EXPENSES IN TWO LOCATIONS. FIRST, A DEDUCTION FROM REVENUE LINE CALLED "CONTRA-REVENUE" CONTAINS THE MAJORITY OF JMH'S ESTIMATED SELF-PAY BAD DEBT. FOR FISCAL YEAR 2011, 95% OF TOTAL BAD DEBT WAS MOVED TO THIS LINE. THIS PERCENTAGE IS SIMPLY AN ESTIMATE OF WHAT PATIENT FINANCIAL SERVICES ANTICIPATES WILL NOT BE COLLECTED AFTER ALL DEBT COLLECTION EFFORTS HAVE BEEN EXHAUSTED. THIS ESTIMATE IS BASED ON HISTORICAL INFORMATION. THE REMAINING 5% OF BAD DEBT IS RECORDED IN THE EXPENSE SECTION APPROPRIATELY CALLED "BAD DEBT". THE FOOTNOTES TO THE AUDITED FINANCIAL STATEMENT REPORT THE AMOUNT OF ESTIMATED UNCOLLECTIBLE SELF-PAY AND EXPLAINS THAT UNCOLLECTIBLE PATIENT ACOUNTS RECEIVABLE ESTIMATED RESERVES ARE BASED UPON PRIOR COLLECTION HISTORY FOR GROUPS OF RECEIVABLES, KNOWN COLLECTION RISKS AND OTHER ENVIRONMENTAL FACTORS, INCLUDING THE AGE OF THE RECEIVABLES.REGARDING LINE 3, IT IS IMPLAUSIBLE TO DETERMINE THE AMOUNT OF JMH'S BAD DEBT ASSOCIATED WITH THOSE PATIENTS WHO MAY HAVE MET THE CRITERIA SET FORTH IN OUR FINANCIAL ASSISTANCE POLICY WITHOUT HAVING A COMPLETED FINANCIAL ASSESSMENT FOR EACH PATIENT. WE ARE UNABLE TO DETERMINE OUR PATIENTS' FINANCIAL CIRCUMSTANCES UNLESS A COMPLETED FINANCIAL ASSESSMENT FORM IS VOLUNTARILY PROVIDED TO US. WE CAN ASSERT THAT MORE THAN 90% OF OUR PATIENTS WHO HAVE PROVIDED COMPLETED FINANCIAL ASSESSMENT FORMS HAVE BEEN APPROVED FOR AT LEAST PARTIAL FINANCIAL ASSISTANCE. OUR VICE PRESIDENT OF PATIENT FINANCIAL SERVICES CONSERVATIVELY ESTIMATES THAT 60% OF TOTAL BAD DEBT EXPENSE WAS ASSUMED ATTRIBUTABLE TO PATIENTS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE.
PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE REPORTED USING JMH'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP DOWN METHOD. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS: TRANSPORTATION OF A PATIENT, COMFORT ITEMS TO INCLUDE A TELEVISION, MAGAZINES, OR A TELEPHONE. ADDITIONAL NON-ALLOWABLE COSTS INCLUDE THE RECRUITMENT OF PHYSICIANS, PHYSICIAN GUARANTEES AND A PORTION OF THE BAD DEBT (30%) ASSOCIATED WITH THE CARE OF THE PATIENT. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. AS A NOT-FOR-PROFIT ORGANIZATION, WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF THE COMMUNITY AND THE INDIVIDUAL WHILE MAINTAINING A HIGH LEVEL OF HEALTH CARE SERVICES WITHOUT LOSSES. SINCE LOSSES DO OCCUR THROUGH THE CMS SYSTEM OF REIMBURSEMENT, THESE LOSSES ARE A COST OF DOING BUSINESS FOR OUR COMMUNITY AND SHOULD BE CONSIDERED A COMMUNITY BENEFIT. AS A PARTICIPATING PROVIDER IN THE MEDICARE PROGRAM, JMH IS REQUIRED TO PROVIDE THE FULL REGIMEN OF CARE FOR OUR MEDICARE POPULATION. THERE ARE A NUMBER OF CARE REGIMENS THAT ARE COMPENSATED BY THE MEDICARE PROGRAM AT LEVELS BELOW OUR COST. THEREFORE IT IS ONLY LOGICAL TO ALLOW MSHA TO REPORT THESE UNCOMPENSATED SERVICES AS A COMMUNITY BENEFIT ON THIS DOCUMENT. BY MAKING THIS CHANGE, NON-PROFIT PROVIDERS WILL BE ENCOURAGED TO SUSTAIN IMPORTANT CARE DELIVERY MODELS FOR OUR AGING POPULATION IN SPITE OF THE FACT IT IS SOMETIMES ECONOMICALLY INJURIOUS.
PART III, LINE 9B: JMH FOLLOWS A STRONG COLLECTION PROGRAM THAT COMMUNICATES FINANCIAL RESPONSIBILITY TO THE PATIENT PRIOR TO SERVICE. COLLECTION PRACTICES APPLY TO ALL PATIENTS, CHARITY AND NON-CHARITY. IN ROUTINE CIRCUMSTANCES WHEN IT IS DETERMINED THAT A PATIENT HAS NOT RESPONDED TO REQUESTS FOR PAYMENT, AN ACCOUNT CAN BE REFERRED TO AN OUTSIDE COLLECTION AGENCY FOR COLLECTION ASSISTANCE. JMH ENSURES THAT OUTSIDE COLLECTION AGENCIES FOLLOW HOSPITAL BILLING AND COLLECTION GUIDELINES. ONCE A DELINQUENT PATIENT ACCOUNT HAS BEEN SUBMITTED TO AN OUTSIDE COLLECTION AGENCY IT CAN BE RETRACTED IF IT IS DETERMINED THAT THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. ALL REQUESTS FOR FINANCIAL ASSISTANCE MUST BE ACCOMPANIED BY A COMPLETED FINANCIAL ASSESSMENT FORM AND SUPPORTING DOCUMENTATION.
PART VI, LINE 2: JMH IS A MEMBER OF MOUNTAIN STATES HEALTH ALLIANCE (MSHA). DURING FISCAL YEAR 2008 AND FISCAL YEAR 2009, MSHA CONDUCTED THE LARGEST COMMUNITY HEALTH NEEDS ASSESSMENT IN ITS HISTORY IN AN EFFORT TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN THE LOCAL REGION. THE ASSESSMENT FOCUSED ON STATE, REGIONAL, AND COUNTY SPECIFIC DATA COLLECTION. THIS ASSESSMENT ALSO INCLUDED PRIMARY DATA COLLECTED THROUGH APPROXIMATELY 50 ONE-ON-ONE INTERVIEWS. THOSE INTERVIEWED WERE INDIVIDUALS FROM AROUND THE REGION WHICH INCLUDED LOCAL AND STATE GOVERNMENT OFFICIALS, HEALTH DEPARTMENT REPRESENTATIVES, PHYSICIANS, GENERAL PUBLIC, LOCAL INDUSTRY, CIVIC ORGANIZATIONS, EDUCATION OFFICIALS, AND COMMUNITY RESOURCE GROUPS. THIS INFORMATION WAS COLLECTED, AND THEN ANALYZED, AND A SUMMARY OF THE FINDINGS WAS LISTED IN AN EFFORT TO OBTAIN A MORE DETAILED SNAPSHOT SPECIFIC TO EACH COUNTY LOCATED THROUGHOUT THE MSHA SERVICE AREA. THIS INFORMATION WAS REVIEWED BY MSHA'S STRATEGIC PLANNING TEAM ALONG WITH GOVERNMENT RELATIONS AND QUALITY DEPARTMENTS. THE MSHA STEERING COMMITTEE IDENTIFIED CHILDHOOD OBESITY AS THE HEALTH DISPARITY TARGETED FOR IMPROVEMENT, INCLUDING THE COMMUNITY SERVED BY JMH.DURING FISCAL YEAR 2009, MSHA BEGAN COLLABORATIVE EFFORTS WITH EAST TENNESSEE STATE UNIVERSITY'S COLLEGE OF PUBLIC HEALTH TO DEVELOP THE MSHA-ETSU OBESITY COLLABORATIVE COMMITTEE. THE FOCUS OF THIS COMMITTEE IS TO PULL TOGETHER MANY PARTNERS AND ORGANIZATIONS IN COLLABORATION TO REDUCE THE LEVEL OF CHILDHOOD OBESITY THROUGHOUT NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. DURING FISCAL YEAR 2011, THE COMMITTEE OFFERED 25 SEED GRANTS OF $2,000 EACH TO LOCAL COMMUNITY ORGANIZATIONS SUCH AS CHURCHES, COMMUNITY GROUPS, SCHOOLS, AND EMPLOYERS THAT WANT TO EXPLORE OBESITY REDUCTION EFFORTS.IN ADDITION TO THE GRANTS PROGRAM, AN ANNUAL SYMPOSIUM IS PROVIDED FREE TO THE REGION AND AVAILABLE TO RESIDENTS AND COMMUNITY GROUPS. NATIONAL, REGIONAL, AND LOCAL EXPERTS SHARE INFORMATION ON TRENDS REGARDING CHILDHOOD OBESITY AND PROVEN COMMUNITY-BASED STRATEGIES TO REDUCE THE PREVALENCE.MOUNTAIN STATES HEALTH ALLIANCE DOCUMENTED ITS CORPORATE RESPONSIBILITY PROGRAMS, PARTNERSHIPS, AND ACTIVITIES FOR COMMUNITY BENEFIT AND SOCIAL RESPONSIBILITY IN THE 2011 SOCIAL RESPONSIBILITY PLAN (THE PLAN). THE PLAN PROVIDES THE STRATEGIC DIRECTION OF SOCIAL RESPONSIBILITY FOR THE ORGANIZATION. MSHA CREATED A SOCIAL RESPONSIBILITY COMMITTEE TO ENSURE A STRATEGIC COMMITMENT TO THE ORGANIZATION'S SOCIAL RESPONSIBILITY THROUGH NEEDS PRIORITIZED FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA IDENTIFIES SEVERAL PRIORITIES TO FOCUS THE ORGANIZATION'S COMMUNITY BENEFIT, COMMUNITY BUILDING AND OTHER INITIATIVES TO IMPACT THE HEALTH OF INDIVIDUALS AND COMMUNITIES WITHIN THE DEFINED SERVICE AREA. THE COMMITTEE MEETS ON A QUARTERLY BASIS AND INCLUDES MSHA BOARD MEMBERS; THE DEAN OF PUBLIC HEALTH AT EAST TENNESSEE STATE UNIVERSITY; THE PRESIDENT AND CEO OF UNITED WAY OF WASHINGTON COUNTY, TENNESSEE; MSHA'S CEO AND OTHER EXECUTIVES AS WELL AS OTHER COMMUNITY LEADERS. THE FOUNDATION OF MSHA'S SOCIAL RESPONSIBILITY IS THE CHNA TO PRIORITIZE FUTURE HEALTH IMPROVEMENT INITIATIVES TO BE COMPLETED IN COLLABORATION WITH LOCAL RESOURCES. THE PROJECT FULLY SUPPORTS THE MSHA MISSION TO "IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH". THE ASSESSMENT FOCUSES ON MSHA'S THIRTEEN CORE COUNTIES. ACTIVITIES ASSOCIATED WITH THE DEVELOPMENT OF THIS ASSESSMENT INCLUDE STATE, REGIONAL AND COUNTY-SPECIFIC SECONDARY DATA COLLECTION AND PRIMARY DATA OBTAINED THROUGH OVER 56 SURVEYS WITH INDIVIDUALS FROM THE LOCAL COMMUNITIES.
PART VI, LINE 3: JMH PROVIDES COMMUNICATION OF FINANCIAL ASSISTANCE ON ITS WEB SITE AND ON POSTERS PLACED IN PROMINENT AREAS SUCH AS ADMITTING AREAS, EMERGENCY DEPARTMENTS AND PATIENT PAYMENT (CASHIER) LOCATIONS. PRINTED EDUCATIONAL MATERIALS INCLUDING FINANCIAL ASSISTANCE CONTACT INFORMATION ARE ALSO PROVIDED IN THE PATIENT'S ADMITTING PAPERWORK. POSTERS AND REFERENCE MATERIALS ARE WRITTEN IN BOTH ENGLISH AND SPANISH. ADMITTING STAFF ARE TRAINED TO EDUCATE PATIENTS ON JMH'S FINANCIAL ASSISTANCE POLICY. JMH ALSO HAS FINANCIAL COUNSELORS WHICH COMMUNICATE THE PATIENT'S FINANCIAL RESPONSIBILITY PRIOR TO SERVICE AS WELL AS PROVIDE EDUCATION ON JMH'S FINANCIAL ASSISTANCE POLICY. THESE COUNSELORS ALSO HELP UNINSURED PATIENTS DETERMINE SOURCES OF PAYMENT FOR MEDICAL BILLS AND HELP PATIENTS DETERMINE ELIGIBILITY FOR PROGRAMS SUCH AS MEDICAID. IN ADDITION, JMH CONTRACTS WITH THE COMPANY FIRSTSOURCE SOLUTIONS USA TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. FIRSTSOURCE SOLUTIONS USA DETERMINES A PATIENT'S ELIGIBILITY IN MEDICAL COVERAGE OPTIONS AND ASSISTS WITH THEIR ENROLLMENT. JMH BEARS THE COST FOR THE FIRSTSOURCE SOLUTIONS USA PROGRAM.
PART VI, LINE 4: JMH IS LOCATED IN ABINGDON, WASHINGTON COUNTY, WHICH IS IN RURAL SOUTHWEST VIRGINIA. THE POPULATION OF WASHINGTON COUNTY IS JUST UNDER 55,000 AND ACCORDING TO THE U.S. CENSUS BUREAU, THE CITY OF ABINGDON HAS A POPULATION OF 8,191. 20.5% OF ABINGDON'S POPULATION IS AGE 65 AND OVER. ABINGDON HAS A MEDIAN HOUSEHOLD INCOME OF $33,524, WHICH IS SIGNIFICANTLY BELOW VIRGINIA'S MEDIAN HOUSEHOLD INCOME.
PART VI, LINE 6: THE MAJORITY OF JMH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY JMH.JMH IS DEDICATED TO OPERATING ITS FACILITIES EFFICIENTLY SO THAT WASTE IS MINIMIZED AND SURPLUSES MAY BE APPLIED TO MAINTAINING ADEQUATE FACILITIES AND EQUIPMENT FOR THE CARE FOR OUR PATIENTS. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY.
PART VI, LINE 7: JMH IS MAJORITY OWNED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA) BASED IN JOHNSON CITY, TENNESSEE. MSHA IS INTEGRATED BOTH VERTICALLY AND HORIZONTALLY AND IS THE LARGEST REGIONAL HEALTHCARE SYSTEM WITH 13 HOSPITALS. IN ADDITION TO ACUTE CARE HOSPITALS, THE SYSTEM ALSO INCLUDES SUCH SERVICES AS: PRIMARY / SPECIALTY PHYSICIAN PRACTICES, URGENT CARE CENTERS, EMERGENCY DEPARTMENTS, OCCUPATIONAL MEDICINE, REHABILITATION, TRANSPLANT, OUTREACH LABORATORY, MENTAL HEALTH, NEONATAL INTENSIVE CARE, A NACHRI AFFILIATED CHILDREN'S HOSPITAL, RENAL DIALYSIS, ST. JUDE'S ONCOLOGY, INPATIENT / OUTPATIENT SURGERY, SKILLED NURSING, HOME HEALTH, AIR AMBULANCE TRANSPORT, AN ORGAN TRANSPLANT DEPARTMENT, AND MORE. WITH THESE ADDITIONAL FACILITIES AND SERVICES, MSHA EXTENDS A HIGHLY EFFECTIVE HEALTH CARE DELIVERY SYSTEM. JMH SERVES AS ITS COUNTY'S PRIMARY HEALTH SERVICE PROVIDER. PATIENTS BENEFIT FROM JMH'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. PATIENTS CAN BE MOVED TO THE SYSTEM'S FLAGSHIP FACILITY - JOHNSON CITY MEDICAL CENTER, WHICH IS A TERTIARY CARE FACILITY PROVIDING ADVANCED TREATMENT OPTIONS.
VAREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrantMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
BARTER THEATRE
127 W MAIN STREETABINGDONVA24210546000120501(C)(3)20000GENERAL DONATION
VA FOUNDATION FOR COMMUNITY COLLEGE EDUCATION
101 N 14TH STREET 15 FLOORABINGDONVA24210237004354501(C)(3)5000GENERAL DONATION
WILLIAM KING MUSEUM
415 ACADEMY DRIVE NORTHWESTABINGDONVA24210541144120501(C)(3)8000SUPPORT FOR THE CENTER FOR ART AND CULTURAL HERITAGE
ABINGDON AMBULANCE SERVICE
611 CAMPUS DRIVE SUITE 600ABINGDONVA24210541061835501(C)(3)21865TO RESTOCK EMS VEHICLESFMVDONATION MEDICAL SUPPLIES
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants4TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
PAUL ARMSTRONG MD
0301203000001256408262032202900
ANN FLEMING
0328461072944041390048481017108050838400
WILLIAM WALKER MD
0512691098124011890001615061361900
SEAN S MCMURRAY
0247007049743012187027167019857035596100
TIMOTHY G EVANS
01520010002523107787014050019906900
STEPHEN K GIVENS
017408900011342010799017085021331500
STEPHEN BLANKENSHIP MD
023203704623602970209948021363033928600
ANN CHANG MD
024114304433602412501534509110033405900
DAVID SIMMONS MD
022373504588302699605382019554032155000
ANDREW HAWKINS MD
0234976045314016565014658016544032805700
STEVEN SIKORA MD
020371303957905020506428016482031640700

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1AJMH PAYS TRAVEL EXPENSES FOR COMPANIONS OF BOARD MEMBERS AND EXECUTIVE STAFF DURING THE ANNUAL BOARD RETREAT. AN ITEMIZED LIST OF EXPENDITURES IS PROVIDED BY THE HOSTING RESORT TO JMH FOR APPROVAL AND SUBSEQUENT PAYMENT. EXPENSES NOT INCURRED FOR BONA FIDE BUSINESS PURPOSES ARE ANALYZED AND REPORTED AS PRESCRIBED BY APPLICABLE TAX LAWS.
PART I, LINE 7DISCRETIONARY BONUSES ARE PROVIDED TO EMPLOYEES WHEN APPLICABLE.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 3THE CORPORATION CONTRACTED WITH MOUNTAIN STATES HEALTH ALLIANCE, A 50.1% MEMBER, TO PERFORM MANAGEMENT DUTIES.
FORM 990, PART VI, SECTION A, LINE 6THE CORPORATION IS ORGANIZED AS A VIRGINIA NON-STOCK, NONPROFIT ORGANIZATION WITH TWO MEMBERS: MOUNTAIN STATES HEALTH ALLIANCE WHICH MAINTAINS A 50.1% MEMBERSHIP AND JOHNSTON MEMORIAL HEALTHCARE FOUNDATION WHICH MAINTAINS A 49.9% INTEREST.
FORM 990, PART VI, SECTION A, LINE 7AMOUNTAIN STATES HEALTH ALLIANCE'S BOARD OF DIRECTORS ELECTS THE MEMBERS OF THE GOVERNING BODY FOR JMH. JOHNSTON MEMORIAL HEALTHCARE FOUNATION'S BOARD OF DIRECTORS ELECTS THE MEMBERS OF THE GOVERNING BODY FOR JMH.
FORM 990, PART VI, SECTION A, LINE 7BCERTAIN DECISIONS OF THE BOARD OF TRUSTEES SUCH AS, DISSOLUTION OF THE CORPORATION, MERGER OF THE CORPORATION, ETC., ARE SUBJECT TO APPROVAL BY THE MEMBERSHIP. DECISIONS RELATING TO THE ORDINARY COURSE OF BUSINESS ARE NOT SUBJECT TO MEMBER APPROVAL.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990, WHICH WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, WAS REVIEWED BY FINANCIAL MANAGEMENT PRIOR TO FILING. COPIES OF THE RETURN WERE MADE AVAILABLE TO THE BOARD TRUSTEES.
ANNUALLY, THE AUDIT AND COMPLIANCE DEPARTMENT PROVIDES THE POLICY AND CONFLICT OF INTEREST DISCLOSURE FORMS TO ALL COVERED PERSONS. EACH PERSON IS REQUIRED TO PROVIDE A COMPLETED DISCLOSURE FORM, NOTING ANY CONFLICTS OF ATTESTING THEY HAVE "NONE", AND RETURN THOSE TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY NOTES DISCLOSURES ARE FORWARDED TO THE APPROPRIATE MANAGEMENT OR BOARD PERSONNEL TO EVALUATE AND UTILIZE WHEN A TRANSACTION INVOLVING A CONFLICTED PERSON ARISES. ADDITIONALLY, PERSONNEL WHO HAVE A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND FORMS ARE REQUIRED TO DISCLOSE THE CONFLICT AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND ENGAGE IN A CONFLICTED TRANSACTION.FORM 990, PART VI, SECTION B, LINE 12C
THE COMPENSATION COMMITTEE, WHICH CONSISTS OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, OBTAINS THE SERVICES OF AN OUTSIDE, INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE THE COMMITTEE WITH RELEVANT MARKET DATA FROM COMPENSATION SURVEYS AND WITH ADVICE WHEN THE COMMITTEE MAKES RECOMMENDATIONS ON PAY AND BENEFITS FOR THE CEO.FORM 990, PART VI, SECTION B, LINE 15
THE CONFLICT OF INTEREST POLICY, IN ADDITION TO OTHER GOVERNING POLICIES, IS AVAILABLE UPON REQUEST. ALL CORPORATE POLICIES AND CORPORATE FINANCIAL STATEMENTS ARE ALSO AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 4,679,911. BOOK/TAX DIFFERENCE ON PARTNERSHIP INVESTMENT -33,523. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 14,378. CONTRIBUTION EXPENSES 88,162. TOTAL TO FORM 990, PART XI, LINE 5: 4,748,928.FORM 990, PART XI, LINE 5:
TRUSTEE COMPENSATION:HOSPITAL BOARD OF TRUSTEES MEMBERS, PAUL ARMSTRONG, M.D., ANN FLEMING, LARAMIE TRIPLETT, AND WILLIAM WALKER, M.D., HAVE 990 REPORTABLE RELATED COMPENSATION DERIVED FROM SERVICES THEY PROVIDED TO RELATED ORGANIZATIONS. THEY DO NOT RECEIVE COMPENSATION FOR SERVICES AS HOSPITAL BOARD TRUSTEES. IN ADDITION, HOSPITAL BOARD OF TRUSTEES MEMBER, EMORY ROBINETTE, M.D. HAS 990 REPORTABLE COMPENSATION DERIVED FROM MEDICAL SERVICES HE PROVIDED TO THE HOSPITAL. HE DID NOT RECEIVE COMPENSATION FOR SERVICES AS A HOSPITAL BOARD OF TRUSTEES MEMBER.FORM 990, PART VII, SECTION A,

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
ABINGDON PHYSICIAN PARTNERS
16000 JOHNSTON MEMORIAL DRIVEABINGDONVA24211205485346MEDICAL SERVICESVA501(C)(3)LINE 11A, IJOHNSTON MEMORIAL HOSPITAL INC0
MOUNTAIN STATES HEALTH ALLIANCE
400 N STATE OF FRANKLIN ROADJOHNSON CITYTN37604620476282HOSPITALTN501(C)(3)LINE 30N/A
DICKENSON COMMUNITY HOSPITAL
ONE HOSPITAL DRIVECLINTWOODVA24228770599553HOSPITALVA501(C)(3)LINE 3NORTON COMMUNITY HOSPITAL INC0
SMYTH COUNTY COMMUNITY HOSPITAL
565 RADIO HILL ROADMARIONVA24354540794913HOSPITALVA501(C)(3)LINE 3MOUNTAIN STATES HEALTH ALLIANCE0
NORTON COMMUNITY HOSPITAL INC
100 15TH STREET NWNORTONVA24273540566029HOSPITALVA501(C)(3)LINE 3MOUNTAIN STATES HEALTH ALLIANCE0
JOHNSTON MEMORIAL HEALTHCARE FOUNDATION INC
16000 JOHNSTON MEMORIAL DRIVEABINGDONVA24211262870970SUPPORTING ORGANIZATION TO JMHVA501(C)(3)LINE 11B, II0N/A
MOUNTIAN STATES FOUNDATION
2335 KNOB CREEK ROAD STE 101JOHNSON CITYTN37604581418862FUNDRAISING FOR MSHA HOSPITALSTN501(C)(3)LINE 11A, IMOUNTAIN STATES HEALTH ALLIANCE0
MSHA AUXILIARY
400 N STATE OF FRANKLIN ROADJOHNSON CITYTN37604581418345SUPPORTING ORGANIZATION TO MSHA HOSPITALSTN501(C)(3)LINE 11A, I0N/A
COMMUNITY HEALTHCARE FOUNDATION
100 15TH STREET NWNORTONVA24273542002314SUPPORTING ORGANIZATION TO NCHVA501(C)(3)LINE 11A, I0N/A

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
INTEGRATED SOLUTIONS HEALTH
400 N STATE OF FRANKLIN ROADJOHNSON CITYTN37604621711997INVESTMENT COMPANYTNN/A
EMMAUS COMMUNITY HEALTHCARE PLLC
6070 HWY 11EPINEY FLATSTN37686200577483MEDICAL SERVICESTNN/A
MEDICAL SPECIALISTS OF JOHNSON CITY LLC
2528 WESLEY ST STE 2JOHNSON CITYTN37604272199037MEDICAL SERVICESTNN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
COMMUNITY HOME CARE INC
1640 PARK AVENUENORTONVA24273541453810MEDICAL PRODUCTSVAN/AC
COMMUNITY PHYSICIAN SERVICES CORP
100 15TH STREET NWNORTONVA24273541641446PHYSICIAN SERVICESVAN/AC
SOUTHWEST COMMUNITY HEALTH SERVICES
PO BOX 880MARIONVA24354541460695HEALTH SERVICESVAN/AC
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
1021 W OAKLAND AVENUE STE 207JOHNSON CITYTN37604621490616PHYSICIAN OFFICESTNN/AC
MEDISERVE MEDICAL EQUIP OF KINGSPORT
1021 W OAKLAND AVENUE STE 207JOHNSON CITYTN37064621212286DURABLE MEDICAL EQUIPMENTTNN/AC
MOUNTAIN STATES PROPERTIES
1021 W OAKLAND AVENUE STE 207JOHNSON CITYTN37604621845895PROPERTY MANAGEMENTTNN/AC
MOUNTAIN STATES MEDICAL GROUP
1021 W OAKLAND AVENUE STE 207JOHNSON CITYTN37604621700412HEALTHCARE SERVICESTNN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1ABINGDON PHYSICIAN PARTNERSBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeBTransactionType
Amount Involved3519671AmountInvolved

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